Radical nephrectomy (RN) for treatment of renal cell carcinoma is a risk factor for end-stage kidney disease (ESKD) during the first year after the procedure, investigators reported at the 2022 International Kidney Cancer Symposium: North America held in Austin, Texas.
During the 5 years after RCC diagnosis, male sex, advanced T-stage, diabetes, hypertension, and chronic kidney disease (CKD) stages 1-4 were significant risk factors, according to Sven Lundstam, MD, PhD, of Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues.
Using the National Swedish Kidney Cancer Registry, the investigators identified 9299 patients with RCC who did not have ESKD at the time of cancer diagnosis. ESKD developed in 215 patients. By comparison, 302 ESKD cases developed among 93,895 matched controls. The 10-year cumulative incidence of ESKD after RCC was 2.5%, half of which occurred within 2 years after RCC diagnosis, Dr Lundstam’s team reported.
Compared with the control group, the RCC group had an 18-fold increased risk for ESKD in the first year after diagnosis and a 7-fold increased risk during years 1 to 10.
On multivariable analysis, patients undergoing nephron-sparing approaches (partial nephrectomy [PN] or tumor ablation) had a significant 61% lower risk for ESKD compared with those undergoing RN during the first year of follow-up, Dr Lundstam and colleagues reported.
Within 5 years of RCC diagnosis, women had a significant 35% lower risk for ESKD compared with men. Patients with T2-T4 disease had a significant 40% increased risk for ESKD compared with those who had T1 disease. Patients with diabetes and hypertension had 89% and 87% increased risks for ESKD compared with patients who did not have these conditions. Patients with CKD stages 1-4 had a significant 15.5-fold increased risk for ESKD compared with those who did not have CKD.
The patients with RCC who experienced ESKD had a significantly lower 5-year survival rate than those who did not (29% vs 64%), according to the investigators. The ESKD group had a 2.4-fold higher risk for death than the group without ESKD.
The new finding differs from that of some previous studies. A nationwide population-based retrospective cohort study of 7670 patients who underwent surgery for RCC in Taiwan revealed that patients who underwent RN have a higher incidence rate of ESKD compared with those who underwent PN (6.9 vs 5.5 cases per 1000 person-years), but the difference was not statistically significant in adjusted analyses, investigators reported in a 2015 article in PLOS One. In addition, in a propensity score matched cohort of patients undergoing RN or PN for RCC (840 patients in each group) in the US, investigators found no significant difference between the groups in the risk for ESKD on multivariable analysis, according to a 2012 report in European Urology. They did, however, find significantly increased risks for CKD, acute renal failure, chronic renal insufficiency, and anemia in CKD.
Lundstam S, Åkerlund J, Holmberg E, et al. Risk factors for end-stage renal disease after treatment of renal cell carcinoma. Presented at: 2022 International Kidney Cancer Symposium: North America, November 4-5, Austin, Texas. Poster 10.
Lin WY, Liang FW, Lu TH. Risk of end-stage renal disease after cancer nephrectomy in Taiwan: A nationwide population-based study. PloS One. 2015;10(5):e0126965. doi:10.1371/journal.pone.0126965
Sun M, Bianchi M, Hansen J, et al. Chronic kidney disease after nephrectomy in patients with small renal masses. Eur Urol. 2012;62:696-703. doi:10.1016/j.eururo.2012.03.051